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At least 181 records · Page 10Linked to original sources
PubMed2003

Segmental nerve damage during a McBurney's incision: a cadaveric study.

Injury to the ilioinguinal and iliohypogastric nerves after a McBurney's incision have been reported to cause paralysis of the conjoint tendon that may lead to the development of an indirect inguinal hernia. This study reports on the incidence of ilioinguinal and iliohypogastric nerve sectioning after the performance of a classic McBurney's incision as well as the distance and relationship of the ilioinguinal and iliohypogastric nerves to the anterior superior iliac spine and a classic McBurney's incision. The right iliac fossa and lumbar region of 33 cadavers were dissected for the uncovering of the ilioinguinal and iliohypogastric nerves after a correct McBurney's incision was made. Injury to the ilioinguinal and iliohypogastric nerves was recorded. The mean distance between the ilioinguinal nerve and the incision line was 41.89 mm and 34.63 mm between the iliohypogastric nerve and the incision line. The ilioinguinal and iliohypogastric nerves were found to be 6.69 mm and 12.08 mm from the anterior superior iliac spine, respectively. No ilioinguinal or iliohypogastric nerve was injured during all 33 McBurney's incisions.

Cadaver↗
PubMedDate not supplied

[Functional anatomy of the pelvic veins in women].

Pelvic veins and lower extremities veins form a functional unit resulting in the interaction of their pathology. The intrapelvic venous system consists of two independent networks, under physiological conditions: the parietal and the visceral networks. The main collectors are the internal iliac veins, the ovarian superior rectal veins. The original venous plexi, located in the sub-peritoneal pelvic connective tissue, remain open because of the adhesion of their wall to the parietal pelvic fascia. The parietal venous network, abundant and supplied with valves, includes the retro-public and sacral plexi. The usual venous drainage is encouraged by abundant anastomoses, the decrease or even the absence of valves and the abdominal pressure. When this pressure increases, especially during walking, this encourages pelvic drainage. Occasional venous drainage is observed in case of obstruction of the usual collectors. Anatomical obstacles to the drainage, besides thrombosis and tumors, are essentially: compression of the left common iliac vein by the right common iliac artery, and direct compression of the inferior vena cava by the uterus during pregnancy which compresses it against the spine. It is responsible for gravidic postural shock, and an increased abdominal pressure, exceeding 20 mmHg. The main supply pathways are the ovarian veins and the vertebral plexi. This large, low-pressure avalvular plexus may function easily in both directions caudo-cranial and cranio-caudal. The relationship of this plexus with the roots of the sciatic nerve explain certain sciaticas during pregnancy. Dilatation of the ovarian veins during pregnancy cause a so called syndrome of the ovarian vein. Various venous compressions during pregnancy are responsible for some hematurias, increased collateral abdominal circulation, and turgescent haemorrhoids and vulvar varicose veins.

Abdomen↗
PubMed2000

The cutaneous nerves encountered during laparoscopic repair of inguinal hernia: new anatomical findings for the surgeon.

BACKGROUND: With an incidence rate of 2%, injury to the nerves of the lumbar plexus is the most common complication of laparoscopic hernioplasty, particularly when the transabdominal preperitoneal (TAPP) technique is used. METHODS: The course of the genitofemoral nerve, lateral femoral cutaneous nerve, and ilioinguinal nerve within the operation site was investigated in 53 adult dissecting-room bodies. Their relationship to the deep inguinal ring, iliopubic tract, and anterior superior iliac spine was also examined. RESULTS: Both the femoral and genital branches of the genitofemoral nerve may penetrate the abdominal wall lateral to the deep ring and cranial to the iliopubic tract. The lateral femoral cutaneous nerve and the ilioinguinal nerve may run immediately lateral to the anterior superior iliac spine. CONCLUSION: Contrary to the previously accepted opinion, dissection and the placement of staples either cranial to the iliopubic tract or lateral to the anterior superior iliac spine can result in injury to the nerves.

Adult↗
PubMed1987

Delayed posterior internal fixation of unstable pelvic fractures.

Fifteen patients with unstable pelvic fractures were treated with immediate anterior external fixation followed by delayed posterior fixation, including five sacroiliac lag screws, six transiliac rods, and four iliac plates. Initial anterior external fixation aided in resuscitation of hemodynamically unstable patients and allowed early mobilization. Delayed posterior internal fixation avoided infection and hemorrhage but failed to achieve anatomic reduction of disrupted sacroiliac joints and sacral fractures. Followup examination confirmed maintenance of fixation and fracture healing but pain and persistent neurologic deficits were common findings. Lumbosacral nerve plexus injuries occurred in patients with fractures through the sacral foramina. Fixation of these fractures with sacroiliac screws and transiliac rods caused overcompression and the resulting foraminal encroachment may be a factor in the lack of neurologic recovery. In this study, delayed posterior internal fixation was not associated with perioperative morbidity and achieved better reductions than those obtained with external fixation alone. Delaying the fixation, however, increased the difficulty of obtaining anatomic reduction of certain posterior arch disruptions.

Adolescent↗
PubMed1989

Response of skin photoplethysmography, laser Doppler flowmetry and transcutaneous oxygen tensiometry to stenosis-induced reductions in limb blood flow.

Photoplethysmography (PPG), transcutaneous oxygen tensiometry (TCpO2) and laser Doppler flowmetry (LDF) were used to measure changes in perfusion of the distal lower limb of the pig, in response to a stenosis created in the external iliac artery. The severity of stenosis was quantitated by the ratio of peak systolic distal pressure to peak systolic proximal pressure (distal systolic pressure index, DSPI). PPG and LDF were immediately responsive to changes in perfusion pressure while TCpO2 responded much more slowly. PPG dropped precipitously in response to even a small reduction in perfusion pressure, reaching zero at a DSPI of approximately 0.3. TCpO2 was insensitive to the presence of a mild stenosis (DSPI greater than 0.6), but was highly sensitive in the range 0.6 greater than DSPI greater than 0.3. At lower DSPI values, TCpO2 also became zero, due in part to electrode consumption of oxygen. LDF readings were sensitive to changes in blood flow throughout the entire range of stenosis, down to the point of total occlusion, although changes were not significant at DSPI values greater than 0.6. Because LDF measures not only nutritional blood flow, but flow in AV shunts and subdermal plexuses as well, high LDF readings could erroneously suggest tissue viability and good healing potential. Resting levels of TCpO2 and LDF can be used to follow the progress of peripheral vascular disease, and used complementarily, in many cases, to evaluate the severity of flow impairment.

Animals↗
PubMed1990

Axial pattern flaps in small animal practice.

Axial pattern flaps are pedicle grafts that incorporate a direct cutaneous artery and vein in their base. Axial pattern flaps have better circulation compared with pedicle grafts, whose circulation is derived from the subdermal plexus alone (subdermal plexus flaps). As a result, axial pattern flaps of considerable dimension have the potential for single-stage development and transfer to cover large cutaneous defects. Development and clinical application of the following axial pattern flaps is discussed in this article: the omocervical axial pattern flap, thoracodorsal axial pattern flap, brachial axial pattern flap, caudal superficial epigastric axial pattern. flap, deep circumflex iliac axial pattern flap (dorsal and ventral branches), and genicular axial pattern flap.

Animals↗
PubMed1986

Arteriogenic erectile impotence.

Organic causes of erectile impotence, including penile arterial insufficiency, is far more frequent than previously assumed. The aim of this review (based on the literature and previous works of the author) is to define arteriogenic erectile impotence, and to describe its pathophysiological and clinical features, the diagnostic approach, differential diagnostic aspects and possible treatment of this type of impotence. Erectile impotence is inability to react to relevant sexual stimulation, with a change in pelvic and penile hemodynamics that will increase the pressure in the cavernous bodies thus enabling vaginal intromission without special precautions; as well as inability to maintain this pressure ordinarily until ejaculation occurs. Arteriogenic erectile impotence is erectile impotence caused by insufficient arterial blood supply to the cavernous bodies regardless of the arterial disease or abnormality responsible for the insufficiency. The normal mechanism of erection is not fully understood. Accumulation of blood under pressure in the cavernous body is brought about by dilation of the arteries to the cavernous spaces and closure of the drainage from the cavernous body. The drainage blockade is active and located just inside the tunica albuginea at the origin of the emissary veins. The mechanism is probably related to the smooth muscles of the cavernous body which become relaxed at the start of erection. Furthermore, passive out-flow restriction probably supporting the active closure when the cavernous body is distended. The autonomic nerves regulating the erection come from Th10-L2 and S2-S4 and pass the pelvic plexus. The target organ neurotransmitters are probably vasoactive intestinal polypeptide and catecholamines. Penile arterial insufficiency can be demonstrated by penile blood pressure measurement either as a simple measurement, or, better, as pelvic steal test and hyperemic stress test. Ultrasonic Doppler pulse curve analysis is another way of demonstrating penile arterial insufficiency. Visualization of the arterial disease causing penile arterial insufficiency requires bilateral selective internal iliac arteriography.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1999

Experimental spinal fusion using sintered bovine bone coated with type I collagen and recombinant human bone morphogenetic protein-2.

STUDY DESIGN: Posterolateral lumbar transverse process fusion using recombinant human bone morphogenetic protein (rhBMP)-2 carried by sintered bovine bone and Type I collagen complex was compared with fusion achieved using autogeneous bone graft or sintered bovine bone alone. OBJECTIVES: This study examined the efficacy of sintered bovine bone coated with Type I collagen as a carrier of rhBMP-2 for lumbar intertransverse process arthrodesis. SUMMARY OF BACKGROUND DATA: Posterolateral intertransverse process arthrodesis using osteoinductive growth factors is performed experimentally in the lumbar spine. The previous studies revealed the efficacy of osteoinductive factors applied to carriers having no bony structures, such as collagen sheet or polylactic acid polymer, for the spinal fusion. However, in their studies, a large amount of osteoinductive proteins have been applied for the spinal fusion. We used the sintered bovine bone "True Bone Ceramics" (TBC; Koken Co., Tokyo, Japan) coated with type I collagen as the carrier. True Bone Ceramics is the only biomaterial possessing a natural trabecular structure and an organized crystal of bone minerals. METHODS: Twenty-two adult rabbits underwent bilateral lumbar intertransverse process arthrodesis at L4-L5. The animals were divided into four groups and had materials implanted as follows: autologous bone group, grafted autologous corticocancellous bone harvested from the posterior iliac crest; implanted TBC group; TBC collagen group, implanted TBC coated with Type I collagen infiltrating into the porous space; and BMP group, implanted sintered bovine bone coated with Type I collagen infiltrated with 100 micrograms of rhBMP-2. Spinal fusion was evaluated by radiographic analysis, manual palpation, biomechanical testing, and histologic examination 6 weeks after surgery. RESULTS: Two rabbits were killed because of infection and lumbar plexus palsy. Radiographs of the BMP group showed a homogeneous fusion mass at the intertransverse area, and stability was confirmed by dynamic radiographs at 3 and 6 weeks after surgery. In the BMP group, a bony mass in the intertransverse area was more prominent than in the other groups. The BMP group had a higher fusion rate based on manual palpation than the-other groups, and BMP fusions showed significantly higher tensile strength and stiffer fusion. The histologic findings in the BMP group demonstrated membranous bone and endochondral bone formations between the transverse process and the fusion mass. In the other groups, continuous trabecular bone formation was observed in the area surrounding the transverse process, but gaps between grafted fragments and less mature bone formation were present in the intertransverse area. CONCLUSIONS: Sintered bovine bone coated with Type I collagen and rhBMP-2 resulted in a higher fusion rate than the autograft and can be used as a carrier for rhBMP-2 in spinal fusion.

Animals↗
PubMedDate not supplied

[Principles of surgery of the deep femoral artery in arteritis of the lower extremities].

The role of the deep femoral artery has too often been ignored in the assessment of arteritis of the lower limb. This anatomical distribution, which seems to be restricted to the thig, has left pride of place to the superficial artery as being responsible for intermittent claudication. In fact the deep femoral artery represents an exceptional and privileged route for anastomosis that is capable of replacing almost perfectly an obstructed superficial femoral artery and also in a more limited way femoro-popliteal arteries with extensive obstructions. The authors estimate that the deep femoral artery represents a true physiological bypass for a thrombosed superficial femoral artery on which a lumbar sympathectomy has a particularly remarkable action. It is important, in order to obtain as good a result as possible, that the flow in the deep femoral artery should be good, which presupposes complete freedom of the iliac axis and good permeability of the trunk of the artery, begining at its ostium. Surgery of the deep femoral artery is short or lon angioplastic surgery depending on the type of lesion, usually involving a venous patch. The surgical approach is straightforward. Whe it is used for isolated lesions or as the last stage of aorto-iliac surgery, delicate angioplasty of the deep femoral artery is a perfectly feasible operation which the authors believe should take its place, in association with lumbar sympathectomy, in the restoration of the superficial femoral artery.

Arteritis↗
PubMed2006

The lymph drainage of the neoplastic mammary glands in the bitch: a lymphographic study.

The purpose of this investigation was to study the lymph drainage of the neoplastic mammary glands in the bitch using indirect lymphography. The main conclusions drawn from the study of 41 natural cases were as follows: the first or cranial thoracic and second or caudal thoracic neoplastic mammary glands usually drain into the ipsilateral axillary lymph nodes and rarely into the ipsilateral axillary and sternal lymph nodes, simultaneously. The third or cranial abdominal neoplastic mammary gland usually drains into the ipsilateral axillary and superficial inguinal lymph nodes simultaneously, but sometimes only cranially into the ipsilateral axillary lymph nodes. Rarely, it drains only caudally into the ipsilateral superficial inguinal and medial iliac lymph nodes, simultaneously. The fourth or caudal abdominal neoplastic mammary gland usually drains only caudally into the ipsilateral superficial inguinal lymph nodes. Rarely, it drains into the ipsilateral axillary and superficial inguinal lymph nodes simultaneously. The fifth or inguinal neoplastic mammary gland usually drains into the ipsilateral superficial inguinal lymph nodes but rarely, does it also drain into the ipsilateral popliteal lymph node and into a lymphatic plexus at the medial aspect of the ipsilateral thigh. Lymphatic connections between the neoplastic and adjacent normal mammary glands were demonstrated in only one case. The lymph drainage pattern of the neoplastic mammary glands is slightly different to that described in normal glands using the same radiographic method.

Animals↗
PubMed2000

Conception of the cervico-brachial protector for motorcycle drivers.

The increasing popularity of motorcycles increases the role of motorcycle accidents as a main cause of brachial plexus injuries. In view of the high social cost of treatment of the victims it seemed desirable to devise some kind of protective clothing for motorcyclists. The protective clothing devised by teams from Department of Neurosurgery, TRICOTEXTIL--and Aeronautics and Applied Mechanics Institute, consists of the following parts: cervical collar--acting against force causing lateral bending and extension of cervical spine, shock-absorptive shoulder pads--acting against the impact energy partially absorbing it and partially transmitting to the dorsal stiff bar, dorsal stiff bar and sacroiliac belt--partially immobilizes the thoracic and lumbar spine, acts against its compression, transmits the impact energy to the iliac crests and hips. The expected biomechanical effects of the cervico-brachial protector are as follows: In brachial region it should diminish the impact energy by its partial absorption and partial transmission along dorsal stiff bar to sacroiliac belt. It should act against excessive cervical spine motion--mainly against lateral bending and extension. It should act against excessive depression of the shoulder. The protective system built in the jacket should co-operate with the helmet of motorcycle driver. It should be comfortable for the driver and conform to security standards. Prototype of the protector underwent kinetic sledge tests in Industrial Motorization Institute (PIMOT), Warsaw, with the use of Hybrid Dummy II.

Accidents, Traffic↗
PubMed2006

Surgical procedures and lymphedema of the upper and lower extremity.

BACKGROUND: Lymphedema occurs in the upper and lower extremity, in a minority of patients, following axillary and groin dissections, respectively. Several technical operative factors have been implicated through the years whose relative significance remains unknown. METHODS: Retrospective review of the author's personal experience with axillary and groin dissections and review of the articles and results written on the author's series of patients. The results, specifically lymphedema, are reported in relation to components of each surgical procedure and the presence or absence of additional surgical procedures, e.g., wide excision of the primary site when performed in the distal leg. RESULTS: In the axilla, skeletonization of the axillary vein, dissection up to and including Level III nodes, removal of the fat and nodes above the level of the axillary vein (exposing the brachial plexus), removal of pectoralis minor and all the axillary fat, exposing thus serratus anterior, latissimus dorsi and subscapularis are all technical components which do not cause lymphedema. It seems excessively thin flaps in axillary dissections may be the most likely cause for upper extremity lymphedema. The incidence of upper extremity lymphedema, in our experience, after axillary dissection is low (2%). For the lower extremity, skeletonization of the femoral and iliac vessels, in continuity dissection of the femoral and deep nodes (iliac and obturator), do not cause in themselves lymphedema (which occurs in 30% of the patients). The incidence of lymphedema increases with making thin flaps, with wide resection of a primary melanoma below the knee, postoperative incidence of cellulites, failure to follow a prophylactic regimen of leg elevation and compression stockings, and obesity. CONCLUSIONS: Lymphedema in the upper and lower extremity may be caused by making thin flaps during node dissection, the additional wide excision of primary sites in the distal half of the extremity, postoperative cellulitis, and failure to follow an antilymphedema regimen.

Axilla↗
PubMed2005

Uterine fibroid vascularization and clinical relevance to uterine fibroid embolization.

Embolization has become a first-line treatment for symptomatic uterine fibroid tumors. Selective catheterization and embolization of both uterine arteries, which are the predominant source of blood flow to fibroid tumors in most cases, is the cornerstone of treatment. Although embolization for treatment of uterine fibroid tumors is widely accepted, great familiarity with the normal and variant pelvic arterial anatomy is needed to ensure the safety and success of the procedure. The uterine artery classically arises as a first or second branch of the anterior division of the internal iliac artery and is usually dilated in the presence of a uterine fibroid tumor. Angiography is used for comprehensive pretreatment assessment of the pelvic arterial anatomy; for noninvasive evaluation, Doppler ultrasonography, contrast material-enhanced magnetic resonance (MR) imaging, and MR angiography also may be used. After the uterine artery is identified, selective catheterization should be performed distal to its cervicovaginal branch. For targeted embolization of the perifibroid arterial plexus, injection of particles with diameters larger than 500 mum is generally recommended. Excessive embolization may injure normal myometrium, ovaries, or fallopian tubes and lead to uterine necrosis or infection or to ovarian failure. Incomplete treatment or additional blood supply to the tumor (eg, via an ovarian artery) may result in clinical failure. The common postembolization angiographic end point is occlusion of the uterine arterial branches to the fibroid tumor while antegrade flow is maintained in the main uterine artery.

Embolization, Therapeutic↗
PubMed1979

[Functional evaluation of reduction of venous outflow from the testis in left-side varicocele in children].

A functional state of venous return from the testicles was estimated on the grounds of a direct measurement of pressure gradients among main points of venous return on 61 unoperated adolescents, aged from 13 to 15, and with marked varicocele; and in 10 children of the same age without varicocele (a control group). The results of the estimation have proved that the hydrostatic pressure in the veins of the pampiniform plexus is directly responsible for their hyperdistension in the vertical position. An exceptional role of renal venous hypertension in the genesis of varicocele in children is doubtful.

Adolescent↗
PubMed2003

Anatomic feasibility of creating an inferior epigastric arterio-venous fistula to develop the internal thoracic artery with a view to coronary grafting.

Arterio-venous fistulae increase the diameter of their feeding artery. It may be advantageous to increase the diameter of the internal thoracic artery before its use for coronary grafting. A fistula applied directly to the internal thoracic artery may compromise its subsequent use as a coronary graft and is technically difficult and invasive. However, in view of the continuity between the internal thoracic artery and the inferior epigastric artery, it is possible to achieve the same effect by constructing a fistula on the latter. The purpose of this work was to determine, in a cadaveric study, the feasibility of carrying out an arterio-venous fistula on the inferior epigastric artery so as to increase the caliber of the internal thoracic artery before coronary grafting. A morphologic study of the inferior epigastric artery and its vein and their relations as well as the feasibility of such a fistula was carried out on 10 cadavers. The epigastric artery measured 12.35+/-1.2 cm in length. Its diameter decreased from its origin towards it termination from 3.16+/-0.26 cm to 1.76+/-0.18 cm. There was a constant connection between the inferior and superior epigastric arteries. This connection was single in 30% of cases, double in 50% and through an anastomotic plexus of more than two vessels in 20%. The mean number of anastomotic connections was 1.8. The epigastric vein was constant with a diameter of 0.75+/-0.06 mm at its origin and only sufficiently large to carry out a fistula at its termination (2.6+/-0.9 mm). In conclusion, this study indicates that it should be relatively simple to create a fistula between the inferior epigastric artery and either the inferior epigastric vein or the external iliac vein.

Aged↗
PubMed1985

The microcirculatory pattern of the transverse-abdominal flap: a cross-sectional xerographic and CAT scanning study.

Following unilateral iliac artery injection of radiopaque Microfil in cadavers, coronal sections of the anterior abdominal wall at 1-cm intervals were obtained employing computerized axial tomography of the intact specimen as well as xerography of frozen slices. Because they avoid the distortion and disruption of the vasculature induced by anatomical dissection, these studies clearly indicate that the arterial supply to zones 3 and 4 of the transverse rectus abdominis musculocutaneous flap is derived through the following systems: the subdermal plexus, and the superficial subcutaneous tissue crossover system. This study substantiates previous anatomical assumptions.

Abdominal Muscles↗
PubMed1989

[Pain in the trochanteric region caused by tunnel compression of the lateral cutaneous perforating branch of the ilio-hypogastric nerve. Indications for neurolysis].

After consideration of anatomical and clinical studies, the authors describe a new tunnel syndrome involving the lateral cutaneous branch of the iliohypogastric nerve as it emerges above the iliac crest. Irritation of the strangulated nerve produces pain over the lateral aspect of the hip. In 7 cases where local infiltration failed, neurolysis was carried out and produced excellent results in 5 patients, thus confirming the pathophysiology of this syndrome.

Female↗
PubMed2001

The blood vasculature as the forming element of the uterus of the estrous donkey (Equus asinus).

Light, scanning electron microscopy of endometrial surface and vascular casts were used to study the vascular architecture of the donkey uterus during estrous. The arterial blood supply of the uterus comes from three arteries: the uterine branch of the ovarian artery, the uterine artery of the external iliac artery, and the uterine branch of the urogenital artery. All arteries enter the uterus at its mesometrial border and divide into smaller ones. Segmentally constricted arteries are seen to circumscribe large veins at the perimetrium which become highly convoluted in the intermuscular vascular layer of the myometrium. Small arteries and arterioles originate at the borderline between the myometrium and the endometrium and radiate to the surface of the endometrium to constitute a system of numerous ridges and grooves by a widely meshed plexus of subepithelial capillary network. The post-capillary venules of the endometrium arise from the subepithelial capillary plexus to form slightly larger veins than the concurrent arteries which join up to the large tortuous veins in the intermuscular vascular layer of the uterus. This arrangement of blood vessels in the donkey uterus and particularly in the endometrium provides the requirement for instant blood flow on the arterial side and for the slow flow rate on the venous side to ameliorate the process of substances exchange.

Animals↗